Tag Archives: relationships

Recovering from the trauma of infidelity

By Lindsey Phillips April 1, 2020

Most people agree that a sexual affair counts as infidelity, but what about sending a flirty text? What if your partner takes out several loans and acquires a large debt without your knowledge? Does engaging in virtual sex with someone other than your partner, connecting with an ex on social media or maintaining an online dating profile even though you are already in a relationship count as betrayal? The answer depends on how the people in the relationship define infidelity.

A recent study commissioned by Deseret News found conflicting answers when 1,000 people were polled about what constitutes “cheating.” The majority of respondents (71%-76%) said that physical sexual contact with someone outside of the relationship would always meet the threshold for cheating. However, a slimmer majority thought that maintaining an online dating profile (63%) or sending flirtatious messages to someone else (51%) should always be considered cheating. The lines on whether following an ex on social media constituted a betrayal were even more ambiguous: 16% said it was always cheating, 45% thought it was sometimes cheating, and 39% answered that it never was.

As this poll illustrates, how one defines infidelity is subjective. Thus, Talal Alsaleem, a leading expert in the field of infidelity counseling and author of Infidelity: The Best Worst Thing That Could Happen to Your Marriage: The Complete Guide on How to Heal From Affairs, stresses the importance of clearly defining infidelity in session. “A lot of therapists make the mistake of not putting enough attention into defining infidelity,” Alsaleem says. “From the first session, if we don’t agree on what to call it, we cannot go any further” because correctly identifying the problem guides which counseling interventions will be used.

If counselors set the stage poorly from the beginning, they risk alienating one or both parties, he adds. For instance, referring to infidelity as “inappropriate behavior” risks minimizing the betrayal. On the other hand, clients and counselors could exaggerate an issue if they refer to something being infidelity when it really wasn’t.

Alsaleem, a licensed marriage and family therapist in private practice at Happily Ever After Counseling & Coaching in Roseville, California, points out that when defining infidelity, research often relies on heteronormative values, which excludes any relationship that does not fit the “traditional” model (read: a heterosexual, married couple). To account for the various types of relationships that exist and people’s microcultures and macrocultures, Alsaleem developed a flexible definition of infidelity that can work for all of his clients, including those who are LGBTQ+ or polyamorous.

“All relationships should have a contract — whether verbal or written — that stipulates the number of the partners in the relationship … the emotional and sexual needs that are expected to be fulfilled in this relationship, and to what extent those needs are exclusive to the partners in the relationship,” Alsaleem explains. “So, infidelity is a breach of contract of exclusivity that you have with the partner(s) … and it’s outsourcing those needs to others outside the relationship without the consent of the partner(s).”

Although having a relationship contract is helpful, it is much less so if the partners maintain implicit expectations of each other that aren’t covered in the contract or if they allow the contract to become static, says Alsaleem, founder of the Infidelity Counseling Center. “It’s very crucial for people not only to have a clear contract in the beginning but also to continue to have those discussions [about their relationship expectations] on a regular basis,” he says.

Alsaleem believes his definition of infidelity not only works for clients of various backgrounds but also provides counselors with a buffer from their own biases about what infidelity is. When it comes to infidelity counseling, “therapists tend to confuse therapeutic neutrality with thinking that they don’t have a role to play,” he says. He asserts that his definition allows therapists to remain neutral without minimizing accountability.

Cyber-infidelity

Technology has provided new frontiers in infidelity because it offers higher accessibility, greater anonymity and opportunities for cyber-infidelity, says Alsaleem, who presented on this topic at the 2020 conference of the International Association of Marriage and Family Counselors (IAMFC), a division of the American Counseling Association. In fact, technological advancements such as virtual reality pornography and teledildonics — technology that allows people to experience physical tactile sensations virtually — are adding new layers of complexity to infidelity and relationships.

People can use technology to escape real-world problems and reinvent themselves, Alsaleem notes. One of his clients suffered from erectile dysfunction. Because of the shame and stigma associated with his condition, he turned to virtual sex as a way to accommodate for the deficit rather than dealing with the issue with his wife.

“Because [technology] is a new frontier, it’s an unchartered territory. Not too many people can agree on what’s appropriate or what’s inappropriate online infidelity behavior because we don’t have a reference point for it,” Alsaleem says. “That ambiguity makes it easier for people to cross those lines because in their minds, they’re not doing anything bad.”

Alsaleem worked with another couple who were in a happy relationship, but their sexual intimacy had decreased because of common life stressors such as work and parenting. Rather than talk to his wife about it, the husband started watching pornography, which evolved into virtual sex. When the wife discovered this, she felt betrayed, but the husband didn’t think his actions constituted an affair because it wasn’t happening in the real world. He considered virtual sex to be an acceptable alternative to “real cheating.”

Situations such as this one further emphasize the need to clearly define infidelity and establish a relationship contract, says Alsaleem, who points out that the good thing about his definition of infidelity is that it applies to both real world and virtual world affairs. Using his definition, counselors could work with a couple to help a partner realize that virtual sex is a form of infidelity by asking, “Was there an agreement between you and your partner that all your sexual needs would be fulfilled by them only?” If the partner acknowledges that this agreement was in place, then the counselor could ask, “Is what you did derivative of sexual needs? If so, did you outsource this need to someone else?” This form of questioning would help the partner realize that he or she did in fact breach the contract of exclusivity.

Transcending relationship dissatisfaction

Relationship dissatisfaction is a common cause of infidelity, but it is far from the only cause. Alsaleem recommends that counselors consider three categories when working with infidelity.

The first is dyadic factors, which are any relationship issues that lead to the couple not having their sexual or emotional needs met by each other.

The second category is individual factors — each partner’s personal history and overall mental health. Counselors should ask about clients’ family history and previous mental health issues, not just their relationship history, Alsaleem advises. He points out that some mental health issues, such as bipolar disorder and narcissistic, antisocial and borderline personality disorders, may increase the likelihood of infidelity.

People who experienced sexual trauma at an early age are also more likely to engage in infidelity as adults because the trauma may have affected their attachment, sexual identity and the type of relationships they have in adulthood, Alsaleem adds.

The third category is sociocultural factors, including a person’s job, culture, family, friends, lifestyle, environmental stressors, etc. Survey data taken from Ashley Madison, a website that helps married people have affairs, reveal that certain careers and occupations are more correlated with infidelity. These careers typically involve frequent travel; expose people to trauma; feature long, stressful hours; or offer unhealthy work environments (among the examples provided were military personnel, first responders, nurses, police officers and people in sales). This finding illustrates how one’s sociocultural factors can facilitate infidelity behavior, Alsaleem notes.

Treating the trauma

Sometimes clients who experience a partner’s infidelity meet the criteria for posttraumatic stress disorder (PTSD), says Gabrielle Usatynski, a licensed professional counselor (LPC) and founder of Power Couples Counseling in Boulder and Louisville, Colorado. In fact, because the emotional response to infidelity (e.g., ruminating thoughts, sleep problems, erratic behaviors and moods, health problems, depression) can mirror responses to other traumatic events, some therapists have started using the term post-infidelity stress disorder to describe this parallel.

“If you pull up the DSM-5 and look up the PTSD criteria and change the word traumatic event to infidelity, it’s almost going to be picture perfect in terms of the symptom criteria,” Alsaleem points out. “There will be triggers, flashbacks, hypervigilance, avoidance behavior, and manifestations related to the knowledge about the affair and everything related to the affair.”

The fallout from infidelity can also spill over into other roles that people occupy, such as being a parent or a professional. This can lead to guilt and shame if they are not performing well in another area because they are preoccupied with the trauma of the betrayal, he says.

Despite having worked for a while with couples in crisis, Alsaleem found that none of the counseling tools he had acquired over the years adequately dealt with infidelity. If counselors use a generic trauma-informed approach with infidelity, they may have a strategy to handle the sensitivity of the issue, but they won’t have a clear understanding of the obstacles and the steps needed to overcome them, he says.

Alsaleem started jotting down observations of his clients dealing with infidelity and discovered several struggles that these clients shared regardless of the type of relationships they had, the length of their relationships, or their cultural or religious backgrounds. These shared struggles included defining infidelity, handling the emotional impact of infidelity, and navigating the significance of the affair narrative. Alsaleem’s observations led him to develop systematic affair recovery therapy (SART), which provides counselors with a treatment method for helping couples process and heal from the trauma of sexual and emotional infidelity.

SART describes seven milestones clients go through as they heal from infidelity:

  • Setting the stage for healing
  • Getting the story
  • Acknowledging the impact
  • Choosing a path
  • Creating a plan of action
  • Implementation and healing pains
  • Sustainability

“Your role [as a counselor] is to help them process what happened, to make sense of it, so this trauma does not define the rest of their lives, whether as a dyad who are rebuilding the relationship or as individuals who have decided to separate and move on to other relationships,” Alsaleem says.

He warns that the process isn’t easy because clients often come in with knee-jerk reactions about what they want to do. Counselors must help clients resist making impulsive decisions and instead encourage them to make up their minds after completing the proper steps and understanding why they are making their decision, Alsaleem says.

With affair recovery, Jennifer Meyer, an LPC in private practice in Fort Collins, Colorado, finds it helpful to have couples write down their feelings and emotions, which can be intense. From the beginning, she asks couples to share a journal and write their feelings back and forth to each other.

After the couple has had time to identify and process the cause of the infidelity, Meyer asks the partner who has been unfaithful to write an apology letter and to read it to the injured partner in session. In this letter, the offending party conveys that they understand the pain they have caused and feel remorse for their actions. Even if the couple decides not to stay together, the letter helps repair the damage caused by the infidelity, and the partners can move forward (and, eventually, into new relationships) without carrying the pain and trauma with them, Meyer says.

Navigating the affair narrative

Some therapists avoid having clients share details about the infidelity because they fear it will create more harm or retraumatize clients, Alsaleem says. He argues that narrating the affair is a painful yet crucial part of recovery that can help facilitate healing if done with the right level of disclosure.

Alsaleem dedicates an entire day in his SART training program to teaching counselors how to help clients share their affair stories without retraumatizing both parties (by sharing too much or too little information) and without minimizing or exaggerating what happened. With infidelity counseling, “every mistake counts,” he says. “When people are coming in after the discovery of infidelity, whether it’s recent or from the past, they are very fragile, so that’s when you need to be strategic and adaptive and plan each intervention and how to respond to the outcome of the intervention.”

Meyer, a member of both ACA and IAMFC, often finds that clients want to ask the offending partner multiple detailed questions about the intricacies of the affair. Meyer is aware that the answers to these questions have the potential to create even more hurt and trauma for her clients, so she is honest with couples about this possibility and guides them through the process.

Alsaleem provides a brief example of how counselors can determine the appropriate level of disclosure when clients share their affair stories (but he advises clinicians to seek further training before trying this approach). He first asks the offending partner to be proactively transparent when sharing the affair story. They shouldn’t hide anything, he says, and they should go out of their way to show the injured partner(s) the unpleasant truths that led to the affair. This is done not to traumatize, he emphasizes, but to show the offending partner’s capacity to be open and honest.

Alsaleem also tells injured clients that they can ask anything they want about the affair. But before they ask, he helps them determine whether the question will help them understand what type of affair it was or why the affair happened. If so, then it is a fair question, he says.

For example, a client dealing with a partner’s sexual infidelity may want to ask, “What specific sexual activities did you engage in?” If the partner who was unfaithful is dealing with a sexual addiction (an individual issue), then the specific sexual activity is not important to understanding the motivation or what went wrong in the relationship, Alsaleem says. However, if the infidelity occurred because of a compatibility issue (a dyadic issue), then that would be a fair question because the betrayed would discover in what ways they are no longer fulfilling their partner’s sexual needs, he explains. 

“The need behind the question [can be] healthy and appropriate, but sometimes [clients are] not asking the right question because they don’t know how to address that need,” Alsaleem adds. He advises counselors to ask clients what they are trying to learn about the story with their questions and help them figure out if these questions are the best way to obtain that information while avoiding further traumatization.   

Affairs can evoke intense emotions in session, especially when discussing the affair story. To ensure that emotions don’t escalate to an unproductive level, Meyer uses a preframe such as “You seem calm at the moment, but this is difficult, and I want to ensure you can both talk without being interrupted. If things get out of hand, I’m going to ask for a timeout. You can both ask for a timeout as well.”

Meyer also uses her own body language — such as scooting up in her chair or standing up — if clients start yelling uncontrollably, or she physically separates them for a few minutes by having them take turns going to the restroom or getting a glass of water. These subtle changes help clients calm down and not get stuck in fighting, she explains.

Creating an imbalance to facilitate healing

Usatynski, an ACA member who specializes in couples therapy, approaches infidelity counseling differently from couples therapy where betrayal is not the presenting issue. In ordinary couples therapy, she strives to keep therapy as balanced as possible, focusing equally on the complaints of both partners and the unresolved issues that each brings to the relationship. But when infidelity is involved, she intentionally creates an imbalance of power and initially allows the injured party to have all of the power. The offending party, on the other hand, does not get to bring any of their complaints about their partner or their relationship to the table until they have successfully addressed the injured partner’s distress. This treatment works only if the offending party expresses true regret for the harm they have caused their partner and expresses a genuine desire to rebuild the relationship, Usatynski adds.

Usatynski’s approach comes from a psychobiological approach to couple therapy (PACT), which is a fusion of attachment theory, developmental neuroscience and arousal regulation developed by Stan Tatkin. When betrayal is the presenting issue, this method requires that clients move through three phases as they process and attempt to repair their relationship.

The first phase addresses the trauma the injured client has experienced by allowing them to express all of their emotions about the betrayal. “It’s when people feel like they have to hold back [emotions] or they can’t get angry or there’s nobody there to listen to them that actually creates trauma or at least makes it worse,” Usatynski says.

The partner who was betrayed can also ask any question they want about the affair during this phase, and the offending partner has to answer honestly. Many therapists who work with betrayal are concerned about the injured partner being traumatized by finding out the truth, Usatynski says. She admits this is a valid concern, so therapists should support the injured partner throughout the process. However, she advises that therapists not shy away from the truth coming out because, as she explains, the only way to repair the relationship or build something new is with total transparency.

If clients are hesitant to ask about the affair, therapists need to explore this hesitation with them. The injured partner may say that they don’t want to know what happened out of an inability to deal with feelings of loss and the practical implications of the relationship ending, Usatynski adds.

During this initial phase, the offending partner has no power to negotiate. They must simply sit and endure the rage and inquiry of the person whom they betrayed, Usatynski explains.

The second phase of PACT involves the offending partner providing the betrayed with whatever support is needed to correct the injury to the attachment bond between them, Usatynski says. This phase could involve declarations of commitment, appreciation or praise, as well as loving actions on the part of the offending partner. However, only the injured partner can decide what behaviors are reparative, she explains. The goal of this phase is resolution.

During the third phase, the injured partner lets the offending partner out of the “doghouse” and, together, the couple decide the new rules and new relationship contract they will have going forward, Usatynski says.

According to PACT, the dysregulation of one’s nervous system (such as during states of hyperarousal or hypoarousal) may lead to discord between the couple, Usatynski says. Thus, counselors should not only track clients for signs of dysregulation but also teach couples how to track each other’s nervous systems.

When Usatynski notices a client showing signs of dysregulation (e.g., changes in skin color, posture or vocal tone), she will ask the other partner if they recognize the change. For example, she might say, “Did you see how your partner’s skin color just changed when he or she said that? What do you think is going on with him or her right now?”

The goal is interactive regulation — the couple learning the specific strategies that soothe, regulate and excite each other, Usatynski notes. “These tracking skills are particularly important in the aftermath of betrayal because … [they help the offending partner] develop a greater awareness of how their behavior affects their partner. These skills also boost sensitivity and empathy,” she explains.

A silver lining?

Alsaleem compares infidelity to a heart attack for the relationship. “It’s a critical wake-up call,” he explains. “It forces [clients] to really lay all the cards on the table and make an informed decision.” Do they commit to fixing all of the deficits and work toward having a better, stronger relationship, or do they end their relationship and find new, healthier relationships?

Alsaleem says several of his clients began therapy devastated by the trauma of infidelity, but by the end, they admitted they were almost glad it had happened because it ultimately led them to having the relationship they always wanted with their partner. For some people, infidelity is the catalyst that ultimately allows them to get unstuck, he explains.

When clients decide to repair their relationship, Meyer helps them develop a new, explicitly stated contract regarding the rules in their relationship moving forward. She asks them to write down their agreement about these new relationship rules (including how quickly they would inform their partner that they experienced a compromising situation and what constitutes infidelity going forward) and ways they could be vulnerable to future affairs.

“As counselors, we can’t assume every couple wants or needs strict monogamy,” Meyer adds. So, this new agreement can take many forms depending on the relationship. For example, partners in a committed relationship may agree that being involved with another person sexually is OK as long as they discuss it first with their partner or keep everything in the open.

Of course, clients in infidelity counseling may also decide to end their relationship. Even so, by showing up to counseling, clients have taken the first step toward ensuring that infidelity does not define the rest of their lives, Alsaleem notes.

“Infidelity is an awful event, but it doesn’t have to be devastating. It actually has a silver lining. Infidelity — as awful as it is to experience, as awful as it is to happen — can actually be a good thing to help people change their lives,” Alsaleem says. “If treated appropriately, it can actually enrich people’s lives and make them more resilient and make them better in the long run.”

 

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Related reading: An online companion article to this feature, “Helping clients rebuild after separation or divorce,” provides strategies for helping clients to process their grief and start over.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Finding strength in sensitivity

By Lindsey Phillips September 24, 2019

When Louisa Lombard, a licensed professional clinical counselor in private practice in California, worked as a school counselor, parents would sometimes come to her saying, “My child is so sensitive. I don’t know why he’s like this. Everything is such a big deal. I parent my children the same way. Why is he like this? His brother’s doing great in school and not throwing tantrums and crying. What’s wrong with this kid?”

In actuality, nothing was “wrong” with the child. What the parents didn’t know was that their child had an innate temperament trait referred to as sensory processing sensitivity. Approximately 20% of the population has this sensitivity trait and is categorized as a “highly sensitive person.” Narrow that focus to the therapeutic world, and closer to 50% of psychotherapy clients possess this trait, according to Elaine Aron, a pioneer in the field of sensitivity, in Psychotherapy and the Highly Sensitive Person.

People with this trait often look carefully before entering new situations or retreat from overwhelming ones. For this reason, they are sometimes mislabeled as being shy, when in fact, an estimated 30% of highly sensitive people are extraverted.

Because no one person’s experience is the same, Aron identified four basic characteristics of the highly sensitive person (also known as the DOES model):

  • Depth of processing
  • Overstimulation
  • Emotional responsiveness and empathy
  • Sensitivity to subtleties

Aron points out that the sensory processing sensitivity trait is a survival advantage in some situations because it allows individuals to process information more thoroughly and increases their responsiveness to the environment and social stimuli.

So, why do highly sensitive people — who have this survival advantage — make up roughly 50% of therapy clients? Julie Bjelland, a licensed psychotherapist in private practice in California, thinks the number is so high because highly sensitive people are a) more responsive to therapeutic work and self-help and b) more likely to have higher levels of stress, anxiety and depression.

Heather Smith, an assistant professor of human development counseling at Vanderbilt University, posits that because these individuals process deeply, they are more inclined to seek out answers and are drawn to counseling for its penetrating conversations. In addition, she says, these clients may have developed low self-esteem because of negative stereotypes about sensitivity, or they might want tools to help them navigate times when they feel more emotional intensity.   

Misdiagnosing a trait for a disorder

According to Erica Sawyer, an American Counseling Association member in private practice in Vancouver, Washington, misdiagnosis of the highly sensitive person often occurs because people aren’t aware that the trait exists or of the trait’s specific characteristics. The scientific name for the trait — sensory processing sensitivity — doesn’t help. The similarity in name between sensory processing sensitivity and sensory processing disorder often leads to confusion. But sensory processing sensitivity is a temperament trait, not a disorder. (Aron notes on The Highly Sensitive Person website, hsperson.com, that sensory processing disorder, on the other hand, is a neurological disorder involving the senses.)

As Lombard points out, most therapists receive limited training on temperaments. She first learned about sensory processing sensitivity after graduate school when her oldest daughter started showing signs of the trait, including being sensitive to noise, facial expressions and food. As Lombard learned more, she realized that she is also highly sensitive. She had long suspected that she had attention-deficit disorder because she had a hard time paying attention in her college classes if another student was kicking a desk in a rhythmic pattern behind her or if there was a bright light overhead in the room.

In fact, because highly sensitive people can get overwhelmed and overstimulated more easily when a lot is going on around them, they can commonly be misdiagnosed with attention-deficit/hyperactivity disorder (ADHD), Bjelland says. However, whereas a highly sensitive person is typically able to concentrate in the right environment — when at home in a quiet room, for example — someone with ADHD might not be, she explains.

One confusing aspect to the highly sensitive temperament is that it doesn’t necessarily produce problems in daily life other than overstimulation, says Smith, a licensed professional counselor and an ACA member. Thus, when clinicians hear about a client’s distress due to overstimulation, they can erroneously attribute it to symptoms of a disorder, she explains. To help prevent this, Smith recommends that counselors investigate whether a client’s issue (such as anxiety, stress or an inability to concentrate) decreases if he or she is no longer in an overstimulating environment. If the client’s issue is still present, then it might be a symptom of a disorder.

Smith also points out that counselors often rely on observable behaviors to indicate a possible symptom or disorder. However, depth of processing is not easily observable, she notes. To help counselors learn to identify this characteristic, Smith describes some cues: Highly sensitive people think more about the meaning of life. If in an environment where they are not overstimulated and their ideas are valued, they have the ability to describe all facets of a problem and generate potential prevention steps or solutions — often before others realize there is a problem. They are observers, not the ones to jump into action. They often don’t make decisions quickly. When they speak, it seems as though they have grasped the insight or concept quickly, in large part because they have been thinking about all of these connections for most of their lives.

One tool that can help counselors assess for sensory processing sensitivity is Aron’s 27-item self-test (see hsperson.com/test/highly-sensitive-test). Smith, Julie Sriken and Bradley Erford analyzed the strength of this scale and found it to be a valid screening instrument that counselors can use in their practices (see “Clinical and Research Utility of the Highly Sensitive Person Scale” published in the Journal of Mental Health Counseling.) Smith presented on this topic at the ACA 2019 Conference.

However, to avoid labeling, Smith cautions counselors against placing too great an emphasis on the cutoff score of this self-test. Instead, she recommends having a conversation about how the client marked each item on the scale. This approach focuses less on the total score and more on the person’s experience overall and with each item.

Smith also advises counselors to be careful about interpreting the results from these test items or problem-solving a client’s distress too early on the basis of these initial conversations. In addition to risking misdiagnosis, counselors run the risk of not being seen as credible by clients who have been deeply thinking about issues related to this trait for a while, she says.

Wired differently

Misunderstandings about the sensory processing sensitivity trait also occur when it is assumed that this population is just sensitive to lights and sounds. It is more than that. The brains of highly sensitive people are wired differently than the brains of other people. A 2018 post on the website Highly Sensitive Refuge notes four differences in the brains of highly sensitive people:

  • Their brains respond to dopamine differently.
  • Their mirror neurons (which allow people to “mirror” the behaviors of others and be more empathetic) are more active.
  • They experience emotions more vividly than others (as enhanced by their ventromedial prefrontal cortex).
  • Their brains are more finely tuned to noticing and interpreting other people.

A recent fMRI study published in Brain and Behavior found that highly sensitive people have increased brain activation in regions related to awareness, action planning, empathy, and self-other processing. Lombard, who specializes in working with teenagers and adults who are highly sensitive, shows clients brain scan images from studies such as this one to illustrate how the highly sensitive brain differs in emotional situations such as watching a scary movie or seeing a picture of a loved one. She finds that these images help normalize the trait for clients.

On a podcast for Unapologetically Sensitive, Esther Bergsma, a counselor in the Netherlands and an expert on high sensitivity, reported that highly sensitive people have more brain activation, especially in the areas surrounding social context (e.g., wondering what others think about them, how others view them, or if others accept them). Bergsma pointed out that always being tuned into social contexts is a strength; it is only when people can’t regulate their emotions well that it leads to increased anxiety and stress.

Because people who are highly sensitive have to process more information and can experience nervous system overload as a result, they can be prone to chronic health conditions if they do not have adequate self-care and downtime, says Bjelland, author of The Empowered Highly Sensitive Person: How to Harness Your Sensitivity Into Strength in a Chaotic World.

She likens the way that highly sensitive people deeply process information to cups of water being dumped into the nervous system (“the container”). Highly sensitive people might have 100 cups that they dump into the container, whereas other people have only a few cups to dump. In other words, these individuals notice and process more detail. For example, a highly sensitive child in a classroom might simultaneously notice that a teacher is upset and the happy expression on a classmate’s face across the room and a tree branch tapping against the classroom window.

One way to simplify these brain differences is to think of the brain as two parts: the emotional brain and the cognitive brain. The emotional part of the brain in highly sensitive people is more activated, and if it becomes too activated, the cognitive part of the brain goes to sleep in a sense, Bjelland says. “That’s why [highly sensitive people] might have a hard time with emotional regulation and can get stuck in worry, rumination, anxiety and overwhelm,” she explains. “During times of high stress, the brain cannot tell the difference between a real threat and a perceived threat, so it sends out alarm bells in the system to prepare for fighting or fleeing. In those moments, [highly sensitive people] can’t even access facts, memory and rational thought because that all comes from [the] cognitive brain.”

However, counselors can teach clients ways to reactivate the cognitive brain to support their system and to let the brain know that it isn’t time to send out those alarms, Bjelland continues. For example, she uses a simple breathing technique to calm the body and let the brain know that the person isn’t in danger. Clients breathe in for four counts, hold for two counts, and exhale for seven; they repeat this for about five to seven breath cycles. “The exhale is very long and slow because that sends a signal to your brain that you are not in danger and that it can stop sending out adrenaline and stress hormones. When you exhale slowly, your brain realizes you are OK because that is not how you breathe when you’re in danger,” she explains.

The counting part (whether done out loud or silently) is important because it helps “wake up” the cognitive part of the brain, she adds.

Reframing the perception of sensitivity

As a highly sensitive person herself, Bjelland grew up hearing the negative messages often directed toward people with the sensory processing sensitivity trait: “Why are you so sensitive? What’s wrong with you? Why are you reacting that way?” When people hear those messages as children, she says, they do begin wondering what is wrong with them.

That internalized message is why psychoeducation about the trait is so important, along with validating clients’ experiences. Most highly sensitive people spend their entire lives feeling misunderstood and that something is different about or wrong with them, Bjelland says. Therapy is the place where these clients can begin changing this narrative and turning it into something empowering, she notes.

In her experience working with this population, Bjelland finds that clients often have a transformative experience once they realize that their temperament is normal, that they are not alone, and that they can take steps to improve their experience.

On the other hand, Smith has noticed that some highly sensitive clients experience a grief response after first learning about the trait. They may need time to grieve that they are unlike the other 80% of the population and yet live in a world designed by those without the sensitivity trait, she observes.

Sawyer, a licensed mental health counselor and art therapist, also helps clients reframe their negative experiences, such as being labeled crybabies as children. Counselors can help clients understand that they feel both negative and positive emotions more intensely than other people do. So, when they cried, they were just naturally expressing what they were sensing, which is normal for someone with this trait, she explains.

“They don’t have the problem,” Sawyer says. “It’s the perception that they have a problem that can turn it into one.” So, rather than thinking that they can’t control their emotions, clients can come to understand that with the right support, they can regulate their emotions. They can also take pride in the fact that they feel not only sadness on a deeper level than most people do but also experience incredible happiness, Sawyer says.

Lombard carefully selected the name of her private practice, Strong and Sensitive, to counter the tendency to equate sensitivity with weakness. Many of her clients come in with low self-esteem because of negative stereotypes about being sensitive. She reassures them that it is a normal temperament variation and not a problem. By normalizing the trait, counselors can help clients to embrace it and see it as a strength rather than a weakness, Lombard adds.

Smith teaches clients to more effectively communicate with those who seem to point out sensitivity as a problem. For instance, rather than taking on the onus to defend their sensitivity, clients could ask the other person, “What part of my sensitivity are you having a problem with?” This question reverses the normal assumption that something is wrong with the client’s sensitivity and shifts the conversation to how the other person may need to adjust his or her language or thinking to help problem-solve the relationship dynamic.

Susceptibility to the environment

Research has shown that in a positive developmental environment, highly sensitive children are more likely to thrive than are their peers who are not highly sensitive. However, in a stressful environment, highly sensitive people tend to do worse than do their peers who are not highly sensitive. In other words, this population is highly susceptible to both the good and bad aspects of their environment — a concept known as differential susceptibility.

A highly sensitive person once told Bjelland that when she was younger, her parents made her wear a wool sweater. After repeatedly asking her parents if she could stop wearing it because the material bothered her, they simply replied, “Wear it anyway.” Bjelland notes that this is an example of a highly sensitive person not being supported, and that circumstance can lead to problems.

Bjelland has also noticed that if a highly sensitive child has anxiety, then almost always one or both parents do too. Therapists can’t easily help anxious children if they have an anxious parent, she says, because the child mirrors the parent and will feel unstable if the parent also feels that way.

Parents who are highly sensitive should also be on counselors’ radar because they can suffer from overstimulation and neglect of self-care, Lombard says. The highly sensitive population is also more negatively affected by sleep deprivation, which is common for parents of young children, Lombard notes. She has noticed that highly sensitive parents are sometimes so focused on being the best parents they can be that they don’t take good care of themselves, pumping breast milk constantly or not making time for meaningful adult conversation, for example.

Lombard and Sawyer both recommend that highly sensitive parents get extra support in the form of family members, friends, daycare or a nanny. If finances are an issue, these parents could consider setting up a rotation with another trusted parent to watch each other’s children on occasion, Lombard says. She also encourages highly sensitive parents to wear earplugs or noise-reducing headphones when appropriate because they turn the noise down a bit and can lessen overstimulation.

Other life changes such as a death in the family, menopause, illness or other stressful events can make highly sensitive people feel unbalanced and overwhelmed, especially if they aren’t taking care of themselves, Bjelland says. If they experience too much emotional activation, they may temporarily lose access to the tools and strategies they normally use to cope with overstimulation, she adds.

To counter this, Bjelland tells clients to keep a “positive journal” to record positive events, such as someone saying something nice to them, or techniques that make them feel good, such as going on a hike in nature. Then, when they are having a bad week, they will have a visual record of self-care tips and positive reminders.

The acceptance of sensitivity within a culture also affects one’s environment. Some clients, but especially men, deny having this temperament because society reinforces the idea that sensitivity is not a positive characteristic, Smith says. (Research suggests that the sensory processing sensitivity trait is equal among men and women.) Thus, counselors should be careful about labeling clients as highly sensitive.

Lombard agrees. In fact, if a client grew up in a machismo culture that considers sensitivity to be negative for men, then she might not directly use the term “highly sensitive person” because it may distract from their treatment or therapeutic progress. “Depending on the culture and family of origin, men can carry more shame around [their heightened] sensitivity,” Lombard says. Instead, she mentions that all people have different temperaments and explains that some situations, such as witnessing a car accident, for example, might affect them differently. She also teaches these clients many of the same coping skills without labeling them as being for highly sensitive people.

Bjelland, who is a global educator on this trait and teaches courses for highly sensitive people, doesn’t see as many self-esteem issues in cultures where sensitivity is more accepted. “In the United States where it’s not so accepted, we see a lot of self-esteem issues. And that’s connected to shame too. Most of us walk around with the narrative that something is wrong with us because that’s what we’ve been told,” she says. “Helping to change the client’s narrative to a positive one, where they recognize why this trait is important to the world, is incredibly important.”

Recently, a male client who identified as highly sensitive came to see Sawyer because he needed a safe space to talk. He was struggling to find and maintain a romantic relationship because he found that women often wanted a stereotypical man — someone bold, assertive and athletic. As they talked, Sawyer discovered that he had internalized the belief that being sensitive was negative, which caused his own social anxieties and made relationships even harder for him. After Sawyer reassured the client that he possessed a normal temperament trait and explained its four main characteristics, he felt less self-judgment.

Although simply providing psychoeducation around the trait can be liberating for some clients, counseling often requires a longer process to help clients begin shifting their negative self-perception of being “weak” or “weird,” she adds.

Mindful changes in an overstimulating world

The good news is that highly sensitive people can makes changes so that their lives are more compatible with this trait and they can more readily cope with the challenges posed by living in an often insensitive and overstimulating world.

Bjelland recommends that highly sensitive people carve out two hours of alone time per day and dedicate one complete day each week to downtime. Not surprisingly, many clients balk at this suggestion, saying they don’t have the available time to do that. Bjelland will ask them to try it for one week and, according to her, they will universally report that they had more energy and were more productive because they were more focused, calm and balanced.

Bjelland also advises clients to follow a slower routine in the morning to help set the tone for the day. Why? Think of the nervous system like a motor, she says. If a highly sensitive person jumps out of bed to get the kids ready for school and then races into work, their nervous system revs up, she explains.

The process of slowing down applies to the bedtime routine as well because, as Bjelland points out, this population often struggles with sleep issues. “If a highly sensitive person wakes up from having a good night’s sleep, they get to have their full 100 points of energy for the day, but if they’re having sleep issues, maybe they’re only going to get 50 points for the day, and they’re already starting out depleted,” she says.

She often tells clients to adopt a ritual of doing the same five things before bed, such as taking a warm bath, reading a nonstimulating book, listening to soft music, meditating, and shutting off all electronics. By the time they reach the third action, the brain realizes sleep is coming, she explains.

“You’re teaching them a new type of self-care because [they’ve] been trying to do what the 80% [of the population that is not highly sensitive] are doing, and it’s not working,” Bjelland adds.

Smith agrees that counselors may need to have conversations centered on how self-care for these clients may differ from what rejuvenates other people. For example, if a highly sensitive person tries to relax by going to a concert with lots of lighting and sound effects after work with friends, he or she may instead feel drained and overstimulated by the end of the night.

Overstimulation is a difficult challenge for people with the sensory processing sensitivity trait because they need so much downtime, Lombard points out. She finds mindfulness techniques helpful for teaching these clients how to stay in the moment and self-regulate. For example, a highly sensitive person may find a coffee shop with loud music and people talking overstimulating. However, counseling can provide the client with strategies to successfully navigate such a space. For instance, perhaps the client limits his or her amount of time in the coffee shop or brings noise-canceling headphones, Lombard suggests.

Because these clients feel so deeply, they often need help learning to calm their nervous systems, Lombard continues. Highly sensitive people “are taking in so much more sensory information, and it’s really overwhelming,” she says. “And sometimes [they’re] not even aware, if [they’re] not mindful, of what it was that made [them] feel down or anxious.” She asks her clients to meditate daily using an app such as Calm or Ten Percent Happier and practice breathing techniques to help them become more mindful, present and calm.

Sawyer also suggests that clients use meditation apps such as Headspace or Insight Timer and practice yoga. Sometimes, even the simple act of closing one’s eyes, listening to nature sounds, or going to a quiet spot such as a bathroom or car can be helpful, she adds. The key is finding activities that “help retrain the brain to slow down [and] pay more attention to what’s happening in [the] body,” she says.

Retraining the brain in this way also helps highly sensitive people realize that they have some control and do not have to feel overwhelmed all the time, Bjelland says. For example, every time clients catch their mind wandering during meditation and bring it back to what they’re focusing on, such as their breath, it is like strengthening a muscle. Then, if clients become overwhelmed at work or a large event, they have trained their brains to notice, and they recognize that they need to take a break, she explains.

To help clients exercise this “muscle,” Bjelland instructs them to ask themselves two questions every time they go to the bathroom: 1) How am I doing? and 2) What do I need? This process makes them aware of preventing depletion or overwhelm, she explains. “Highly sensitive people tend to be very externally focused because they’re always scanning the environment for other people’s needs,” Bjelland says. “Most highly sensitive people need to be taught how to explore internally to learn what they need without always filtering it through other people’s needs.”

Of course, the heightened sensitivity to one’s environment also has benefits. Smith has often heard highly sensitive people talk about spending time in nature because there isn’t as much stimulation there. It is a place where they can escape and delight in the beauty of the natural world.

For some highly sensitive people, listening to a bird chirp or watching a sunset can elicit intense feelings of joy or elation, Sawyer says. Spending time in nature — simply walking barefoot in the grass, for example — can also help calm the nervous system, she adds.

Lombard recommends that counselors take these clients outside if they can or, alternatively, bring the natural world into their offices with nature sounds or a water fountain to help create a sense of calm. Lombard has noticed that clients often feel calmer when they see, touch or hear water, so she frequently has clients listen to the sounds of a rainstorm or flowing brook.

Learning to communicate one’s needs

Although highly sensitive people’s empathetic nature often makes them great partners in life and work, relationship issues are one of the primary reasons that they seek counseling. “Highly sensitive people in relationship are going to be so attuned to what the other person is feeling that sometimes they allow that to dominate over their own needs,” Smith says. For example, they may take on more work to please their boss even when they are already overwhelmed.

Smith finds role-play beneficial for helping these clients learn how to assert themselves in relationships. In counseling, they can safely practice communicating their own needs even if it initially seems strange or dramatic to them, she says.

Because highly sensitive people often hold themselves up to the standards of the 80% of the population that is not highly sensitive, they may not be aware that they need more downtime or need to do less so they can maintain their health and wellness, Sawyer says. To help these clients identify their needs and build new habits and coping strategies, she sometimes has them create a values collage of images that speak to them or make them feel good. Through this visual exercise, clients often will discover a common theme, such as nature. The values collage also serves as a reminder of ways that clients can calm an overstimulated nervous system the next time they find themselves in a stressful or overwhelming situation, Sawyer says.

For example, if a client’s collage contains mainly pictures of the ocean, Sawyer will ask how much time the client is spending near the beach or water. If the client says only once or twice a month, Sawyer will recommend increasing the time that the client engages in activities that will replenish them. For example, the client could go for regular walks on the beach or, if that isn’t feasible, pull up YouTube videos of ocean waves and sounds or simply take a bath to connect with water.

Working with these clients also involves helping them learn to set boundaries and communicate their needs, Sawyer says. She finds that nonviolent communication, an approach developed by psychologist Marshall Rosenberg, is a useful tool for highly sensitive people because it provides them with structure for setting boundaries. This type of communication involves:

  • Observing what does or does not contribute to their well-being
  • Identifying how they feel in relation to what they observed
  • Identifying the needs or values that cause their feelings
  • Making a request to fill that need or have that need met (the concrete actions they would like to see)

Sawyer provides a hypothetical case example. A highly sensitive person is worried about going on vacation with her friends because they are extraverted. The client also fears she will be expected to participate in every activity they have planned and that she won’t get enough downtime. First, Sawyer would help this client identify her needs and preferences for this trip. The client says she would like to have the room farthest away from the common areas because it will provide less stimulation if others stay up late talking. She would also like to tell her friends that she will opt out of an activity to stay in and read.

Next, Sawyer and the client discuss her fear of appearing antisocial if she communicates these needs to her friends. Sawyer uses emotional freedom techniques to help the client ease that fear and calm her nervous system. She asks the client to identify her fear. The client responds, “I feel nervous about talking to my friends.” Sawyer then asks where she feels that fear. The client says, “My stomach feels like it has butterflies.”

After ranking the intensity of the feeling (on a scale from 1 to 10), the client taps different pressure points while repeating the phrase, “Even though I feel nervous about speaking to my friends, I deeply and completely accept myself.” The goal is to have the intensity of her fear drop to a 2 or below.

Next, Sawyer and the client role-play scenarios of the client having this conversation with her friends. For example, she could say, “I’m someone who needs downtime. Would it be OK if I stay in from an outing so I don’t feel so anxious?” or “I’m excited about this trip and love hanging out with you, but I wanted to let you know that I will probably need a couple hours of alone time each day.”

Being a more sensitive counselor

Highly sensitive people “have higher responsivity to counseling interventions,” according to Smith. “Where they have positive fit with the counselor, they do better or they have more of a treatment response, and they seem to get more out of the counseling relationship.”

But how can counselors ensure that they are a good fit for a highly sensitive client? Smith recommends that counselors first think about their own temperament because it will inform any strategy they use. Are they highly sensitive, or are they among the other 80% of the population? At the same time, highly sensitive therapists shouldn’t assume that clients’ experiences are the same as their own, she adds.

“The 80% are very capable of working with highly sensitive people, but they need to be very careful of their own biases because they represent the majority,” Smith continues. “They may jump to a conclusion, or they may have some internalized negative biases of people who are highly sensitive.” If counselors aren’t aware of their internal biases, they risk unintentionally perpetuating some of those negative messages in the therapeutic process, she says. “And the highly sensitive person is coming to counseling because they’re looking for something different than what they’re getting in society.”

The good news is that “many counseling approaches would work well if the counselor is able to adapt it in light of what they know of the client’s high sensitivity,” Smith says. For example, if the counselor stares intently while the client is doing a sand tray intervention, then the client could become overstimulated and have a negative experience, making the intervention less effective, she explains. Instead, the counselor could step back and say, “I’m going to let you do this activity for 10 minutes. I’ll be over here doing my notes.”

Counselors should also think about the way they use language and how the highly sensitive person might perceive it. “The highly sensitive person is probably going to pick up more on nuanced language because, in general,” Smith says, “they’re wired to pick up more subtleties in their environment.” This also includes tone of voice, surroundings in an office, and nonverbal language, she adds.

Bjelland advises counselors to consider the environment in their offices. Is the lighting too bright? Is the client looking into a window? What is the texture of the couch? Does the office have a lot of strong smells such as cleaning products, perfumes or incense?

Smith also cautions counselors to be careful with cognitive behavior therapy. Because highly sensitive people process their environment and emotions deeply, asking them to think about cognitive distortions — the simple ways that the mind convinces a person that something isn’t true — can seem simplistic to them. It can even come across as patronizing to ask a highly sensitive client to reframe a cognition when he or she is having thousands of cognitions on a very deep level, Smith adds. Instead, she suggests saying, “Are these cognitions or depths of processing working well for you, or are these cognitions moving more into rumination?”

Counselors should also be careful when using interventions that might not value the depths of processing because they may unintentionally indicate that there is something wrong with the way the client is processing information, she notes.

Counselors also have the opportunity to reinforce clients’ gift of high sensitivity by validating the strengths and positives of the trait, Smith says. For example, a teacher might feel frustrated because he or she can’t soothe a crying boy. But a highly sensitive child in that same class probably would have noticed that the boy is upset because his crayon rolled under his desk, or the highly sensitive child might even notice the crayon rolling under the desk before the other child does and could grab it and prevent the boy from getting upset in the first place.

Thus, working with highly sensitive people can have far-reaching effects. As Bjelland points out, “You’re really creating a domino impact across the globe when you help a highly sensitive person lift off that layer of overwhelm and help them access those gifts and teach them how to care for their sensitive system because when they are thriving, they go out and help people and make a difference in the world. It’s just who they are.”

 

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The highly sensitive therapist

Many professional counselors don’t just treat highly sensitive clients — they have the sensory processing sensitivity trait themselves. Find out how they manage the benefits and challenges of this trait in the article “Advice for the highly sensitive therapist,” available exclusively at CT Online.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

 

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The miscommunication model and the WDEP system

By Barbara A. Mahaffey June 4, 2019

Helping clients keep or revitalize loving relationships are long-term goals for those who specialize in couples counseling. Those goals get derailed when one or both clients storm out of the room during the middle of a heated debate during an intake session. Therapeutic ruptures and divorces can happen if counselors fail to quickly mediate couples’ arguments, especially if the counselor has not yet established credibility and an alliance with the clients.

Success in couples counseling sometimes depends upon gaining a therapeutic alliance with both partners while simultaneously preventing or resolving emotional outbursts. However, simply teaching couples polite ways to communicate will not keep them together, according to John Gottman. Another technique or approach is warranted. Couples who come to counseling are seeking relief from anger, tension and communication breakdowns, so it makes sense for us to offer them a new way of relating to each other.

I developed a technique to help couples communicate and self-disclose in a nonthreatening way and used this technique as my intake in private practice starting in 1996. What is different about this creative technique? The secret may be the miscommunication model. I found the missing key to helping couples alter communication patterns was engaging them in creating a drawing that contained the reasons they struggled to keep calm and communicate their needs and wants. While completing this drawing, people gained insight into the ways they had been miscommunicating.

What is lacking for many couples is the ability to debate, relate and communicate without blame, shame and anger. While drawing the miscommunication model, each person recognizes that communication is difficult and that everyone struggles with multiple barriers. For most, the drawing is a cathartic exercise that can shift the common blame-game conflicts to goal setting and nonthreatening communication opportunities.

Most people come to counseling with the expectation of a tell-all session focused on disclosing problem after problem, or they complete a checklist of problems before a session begins. Unfortunately, intervention strategies specific to preventing or defusing negative or emotionally charged situations is a skill gap in counselor education. This raises an important question: How do counselors gain trust simultaneously with two strangers, provide tools to promote their affective connection, and prevent outbursts and ruptures during a volatile first session?

Establishing multiple therapeutic alliances

As is the case with individual counseling, a therapeutic alliance is the most important factor in successful couples counseling. Gaining a therapeutic alliance with two people simultaneously is a multifaceted challenge, however, especially when these individuals are trying to describe relationship concerns and upsets to a stranger.

Conflict resolution for couples begins after a counselor establishes ground rules and structure during the intake session. The first important rule is to establish how clients can have a calm session. If a first session is filled with anger and centered on problems, counselors will find it more difficult to form a bond with these individuals. Establishing a nonthreatening review of couple challenges is one way to provide catharsis, encourage openness and set ground rules. Sessions should also end with goal setting to keep a calm home environment in between sessions.

I developed the miscommunication model during years of intake assessments to deescalate anger and promote a working relationship among all people in the counseling room. As part of the effort to establish an alliance with both people simultaneously, the model provides counselors with a way to demonstrate barriers to a satisfying relationship while establishing nonthreatening goals and tasks. The first tasks are to provide the mechanism through which each client will participate in counseling, learn about barriers to healthy communication, and gain awareness of ways that relationships can be derailed. In demonstrating the miscommunication model, counselors can then help couples learn to express what they want.

Clients may not come to counseling with a set of rules for governing appropriate self-disclosure. Therefore, counselors can introduce the tenets of choice theory’s WDEP (want, do, evaluate, plan) system concurrently with the miscommunication model to add a directive structure to counseling sessions, according to internationally known choice theorist Robert Wubbolding. The purpose of combining the WDEP system and the miscommunication model is to first outline how common traits, past experiences, barriers, learned patterns, language and its meanings, emotional reactions, life interference and family rules contribute to a breakdown in couple communication, and then to introduce a way to build a happier relationship.

The miscommunication model approach to intake interviews

The miscommunication model was developed to help clients understand and conquer the many barriers to an improved relationship. One potential helpful insight is that people can and often do have different “wants” or needs in a relationship. Choice theory’s WDEP system provides structure when integrated in this model.

In some cultures, relationship conflict begins when one of the partners in a couple believes that both partners should share common wants. Counselors can provide conflict-resolution templates to help couples thwart power struggles (for example, by getting the couple to focus on helping each other attain goals rather than focusing on whose wants are more important). Guiding couples to learn aspects of negotiation and acceptance are additional ways that this model promotes a healthy relationship.

What has been missing in previous approaches to couples counseling is engaging couples in a conversation about the ways that anyone can be misunderstood when trying to communicate. One way to engage clients in intake sessions is to draw a diagram denoting two people communicating and then to explain the common barriers to and complexities of relationships. Framing this information in a way that suggests that interpersonal communication can be improved adds hope for couples with relationship ruptures.

Miscommunication barriers vary, and the model illustration on page 39 shows only a small sampling of these barriers. Clients can be encouraged to come up with more examples that fall under headings such as personal characteristics, past experiences, brain lies, family rule books, rate of talking versus rate of thinking, life event disruptions, and words and definitions. Counselors who draw a miscommunication model — with clients’ input — can integrate the goal-setting WDEP system tenets of “what are our wants,” “what will we do,” “evaluate” and “plan for and create a quality world.” This is a refreshing new way to engage clients in a nonthreatening conversation.

People who come for couples counseling typically have not been able to resolve their differences and are seeking assistance to do so. Learning that people miscommunicate many times a day helps to remove some of the blame, shame, guilt and anger that are often present in these relationships. These negative emotions can be the underlying cause of a ruptured relationship. Learning about the many ways that miscommunication has disrupted their relationship also serves to add skills to the couple’s toolbox. It is important for counselors to normalize the frequency of miscommunication by pointing out that everyone differs in some way and that disagreements are commonplace, not the exception.

Personal characteristics

Discussing the barriers that hinder relationships can be tricky business. People depend on counselors to lead conversations about problem-solving though, and the place to begin is by talking about the “elephants in the room.”

The first barrier to communication in the miscommunication model is each person’s differing characteristics. Each person has different traits, cultural influences, coping and defense mechanisms, learned behaviors, circumstances and life predicaments that can hinder relationship harmony. Some clients can easily list other attributes that differ, including age, race, religion, education, interests, abilities, sibling status, and work or military experience. Others may note differences in body language, personalities, parental influences, relationship histories, likes and dislikes, communication habits and health issues. A few clients might disclose traumatic experiences, medical histories and pre-existing thoughts about counselors or the counseling process.

This extensive list can be developed over several sessions if warranted. Counselors can explain that many of the barriers will be unspoken and unconscious. It is sometimes appropriate for counselors to note that barriers can be kept secret to protect the emotional safety of the clients. One example of this is that clients are not pressured to disclose childhood abuse. Significant others or spouses may not realize that certain topics are “off limits” for the other person in the room.

Preventing session blowups and engaging clients in a calm conversation about what has changed in their relationship involves helping couples gain insights into their communication skills. At some point in their couplehood, their ability to discuss what they want/need and how to share problems changed.

Sometimes the differences or discrepancies in how people relate to one another are obvious and sometimes not. When discussing relationship barriers, it is wise to point out how a person’s past or lived experiences can create a block to understanding another person’s actions, decision-making, problem-solving abilities, and likes or dislikes. For example, a couple might argue about going to a certain restaurant without being able to talk about a past negative experience that is influencing the thinking, emotions or actions of one of the partners. The miscommunication model would focus attention on this important discussion topic by adding it as a conversation bubble for one of the communicators in the drawing.

Talk about family rules

One way to introduce the “family rules” miscommunication barrier is to discuss the family-learned communication styles that Virginia Satir wrote about in Peoplemaking. Her communication styles and “family rule books” of placater, distractor, computer, blamer and open communicator can be added between the two people in the miscommunication model drawing. This is the counselor’s judgment call and depends on how volatile the couple’s relationship can be.

Another Satir concept, “can of worms,” illustrates the complicated communication patterns in families and can be added in a future session should it become a hot button issue. If a client points out that the other person’s family has a rule book of open warfare and verbal onslaughts, I recommend noting this as a topic for a future session.

Another family rule book example that can be noted for future discussion is the concept of “life expectations.” Many times, derailed personal goals connected to children, work, education or bill paying can be hidden aspects behind relationship dissatisfaction. Although understanding a client’s values, morals and beliefs is an important part of establishing trust and a therapeutic alliance, an intense discussion around these topics can derail the focus on issues during the first session. It may be beneficial for counselors to be directive and to suggest that such topics be developed in future sessions, after the therapeutic alliance has been well-established among everyone involved.

Normalize individual differences

Yet another barrier to communication is our personal brain differences. Part of the benefit of the miscommunication model drawing is the catharsis clients feel when they realize that many other people have struggled to keep a relationship thriving. Counselors might point out the many possible differences between people in learning styles, intelligences, interests, values/morals and perceptual acuities/filters. Also, people “screen” in and retain information differently, yet they may not realize these differences.

In the miscommunication model, these differences can be demonstrated by drawing two brains and pointing out the different ways, speeds and processing pathways for each person. For example, Person A may process and filter by using cognitions or thoughts first. Person B may process by filtering feelings first. Yet another person can believe that they verbalized a thought even when they didn’t because we think faster as humans than we speak. Drawing the two brains can aid in emphasizing that each person in the relationship has unique qualities. Note that people have different processing speeds and rates of speech too. This provides clients with an opportunity to gain awareness and new insights.

Some counselors who draw the miscommunication model use the phrase “our brain lies to us” to describe another barrier: conceptualizations. To help clients grasp the concept that the brain sometimes “lies,” counselors can offer the examples of optical illusions or mistaken perceptions by witnesses. Some clients may resist the notion that their brain isn’t always a dependable source of accurate perceptions. The knowledge that information is not always perceived, interpreted, processed and retained correctly can be unsettling. Counselors may wish to ask permission to point out inconsistent communication to highlight instances when the “brain lies.”

When drawing the miscommunication model, counselors can also add the ways that people differ genetically, developmentally and stage/age wise, and then discuss those aspects.

The miscommunication model next leads to introduction of the Do tenet from the WDEP system. This helps clients shift to a discussion about how to resolve or respect individual differences.

Daily life barriers

Daily life disruptions are constant sources of miscommunication. Any number of new or co-occurring outside events can affect a person’s relationship and communication quality. Family, work, environment, health issues, money issues and other stressors can add to a person’s strife and grief. In the miscommunication model, the importance of these variables could be added or symbolized as a conversation bubble that is drawn or attached to the second person in the couple interaction. The risks involved in second marriages, deaths in the family, and child rearing are common topics within this barrier. During this discussion, counselors may engage clients in ideas about evaluating their situations, establishing their plans and setting goals.   

Words and language as relationship barriers

Words are one of the biggest hindrances to successful couple communication. How a person defines a word or phrase can cause grave misunderstandings, especially when there is a lack of clear definition related to emotions. I would caution counselors not to ask clients, “What is your definition of love?” because that query can result in a storm-filled diatribe in session. Conversely, pointing out that emotion-laden words such as love may be defined in many ways can be a healing approach.

Miscommunication also happens in cultural and historical contexts. Newly created terms used in texting, social media and alternative forms of communication (such as meta communication) only sometimes have shared meanings. For example, one couple split their household over the phrase, “I am done.” One spouse interpreted this as the intent to divorce, whereas the other spouse interpreted it as meaning their conversation had ended.

Another couple’s rupture was healed after talking about how one of them expressed love through behaviors rather than verbally. The husband realized he had learned about love from watching John Wayne movies and had internalized a belief that “I don’t have to say I love you, I just do.” He also learned an important evaluation skill — that challenging a learned reaction and confronting a prior belief could benefit both him and his wife. His wife benefited from learning that he was not intentionally dismissing the words that would typically be used to express an affective connection. She also started observing the favors and actions he did to show his caring for her between counseling sessions. This problem resolution happened because of her request to “receive the gift of a verbal love commitment — the statement of ‘I love you.’”

I have seen couples benefit from discussing throughout the counseling process words that have different meanings or definitions. Some examples of words that often have different contexts or descriptors include committed relationship, separation, affective connection, friendship, change and going steady.

Integrating WDEP’s problem-solving steps

The final aspect of the miscommunication model and the integrated WDEP system is the creation of a plan. (While the evaluation aspect of WDEP is not elaborated on in the model, it is part of the ongoing discussion orchestrated by the counselor in the room.) The plan can have three goal sections — one for each member of the couple and one for the couple as a unit. Each person is given a chance to state one goal that will facilitate the creation of their “quality world.” This is an important aspect to goal attainment and success, according to Wubbolding and his associate, John Brickell.

Typically, the couple goal is a fun and easy task or set of tasks. One of these might be to plan an activity in which both individuals create a new interest together and then report back to the counselor about what was accomplished. The plan should include a timeline and should feature positive, mutually agreed upon and doable activities, according to Mark Young, a counselor educator at the University of Central Florida.

One of the skills that counselors can model during the session termination phase is to frame plan changes in positive ways. For instance, instead of wording a goal with terms such as “unmet expectations,” counselors can help clients set goals that are “gifts for each other” that lead to relationship improvement.

Drawing the miscommunication model and integrating the WDEP system on a piece of paper that the couple can take home is a great way to assist them in recalling homework, goals and barriers to future interpersonal communication. It also is an unexpected presentation method. One benefit to drawing the dynamics of interpersonal communication is that couples can come to future sessions better prepared to diagram their miscommunications. This paves the way to increased insights about their conflicts and arguments.

When counselors try to teach clients different or accepted ways to communicate without first gaining their trust and, more importantly, their insights into barriers to communication, they often fail to help couples improve and stay in committed relationships. Relationships can improve, but it involves a process of learning how communication can go in a wrong direction. People can more easily change their attitudes and opinions about each other if they are given information that empowers positive change. The miscommunication model is a tool that couples can use to discuss their individual wants, intentions, behaviors and plans.

Simultaneously conducting an intake assessment and providing education about how to navigate relationships has been successful in helping me prevent couples counseling ruptures and storm-filled counseling sessions. Counselors can combine the miscommunication model with the WDEP system for a directive approach that leads to problem resolution.

 

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Helpful resources

  • “Applying reality therapy’s WDEP tenets to assist couples in creating new communication strategies,” by Barbara A. Mahaffey and Robert Wubbolding, The Family Journal, 2016
  • “Couples counseling directive technique: A (mis)communication model to promote insight, catharsis, disclosure and problem resolution,” by Barbara A. Mahaffey, The Family Journal, 2010
  • “Therapeutic alliance: A review of sampling strategies reported in marital and family therapy studies,” by Barbara A. Mahaffey and Paul F. Granello, The Family Journal, 2007

 

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Barbara A. Mahaffey is the executive director of the Scioto Paint Valley Mental Health Center, an agency that serves clients in five counties in Ohio with outpatient and residential facilities. Contact her at bmahaffey@spvmhc.org.

 

 

Letters to the editor:  ct@counseling.org

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

How can we truly help clients in a relationship?

By Chris Warren-Dickins April 4, 2019

Couples therapy has been around for years, so it is easy to believe that we know everything we need to know about its underlying principles. Assumptions can lead to an overly narrow perspective, however, so I’d like to offer 10 ideas on which to reflect when it comes to couples therapy.

 

1) “Couples” are actually “relationships”: Perhaps the first way to truly help couples is to stop using that very term — couples. That’s because the term assumes a monogamous relationship between only two people and therefore excludes polyamorous relationships and any other type of romantic relationship. It might be argued that the term leaks something about our personal values, much like an assumption that a “marriage” can be between only a man and a woman. For that reason, I prefer to use “relationships” instead of “couples work,” and I refer to “clients in the relationship” rather than the “couple.”

2) Leakages of personal values: Of course, there is a risk that as counselors, we also leak our personal values in individual work. But it seems to me that the greater the number of clients sitting in the room with us, the greater the chance for this leaking to occur. When we work with relationships, we often see the interaction between the different members of that relationship. In real time, we bear witness to the dynamics of that relationship, and it can be challenging to have that played out before our very eyes. 

In our training, we are encouraged to intervene a great deal more in our work with relationships than we might if we were working with an individual client. We are told that there are more opportunities to offer alternative ways of relating to each other, and if we do not seize these opportunities, then the relationship may end up following the same patterns and learning nothing from therapy.

The question is, what is informing our intervention? Is it what we are actually witnessing in the relationship, or is it our own personal values and assumptions? For example, if we are witnessing a male and female client in a relationship, are we inclined to assume that the male client will be more domineering than the female client? I have worked with a number of professionals who made assumptions about domestic abuse, sexual violence and domineering behavior in general. They often leaked their assumptions that the only possible victims in these scenarios were female and that the only possible perpetrators were male.

The ACA Code of Ethics is clear. Standard A.11.b. says that a counselor should not refer a client to another counselor simply because there is a conflict in “personally held values” between the counselor and the client. Instead, counselors should “respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” I would imagine that this can prove extremely difficult for some counselors, particularly if their personal (for example, religious) values conflict with the client’s goals. However, as we have seen from cases such as Ward v. Wilbanks and Keeton v. Anderson-Wiley, this does not give a counselor the right to refuse to work with that client. 

3) Formed alliances: If our own personal values are more in line with one of the clients than the other member(s) of the relationship, we could easily get dragged into an alliance with that client. For example, the counselor might share with one of the members of the relationship the personal value that a relationship must be preserved at great cost when there are children involved. But if this does not reflect the personal values of all members of the relationship, the counselor’s role is to remain focused on the goals agreed to by all the members of the relationship. To help with this, we can remind ourselves that the dilemma is not ours to resolve. We can work hard to help the members of the relationship resolve the dilemma, but we do not have to resolve it for ourselves.

Individual client work requires us to monitor the boundary between us and the client. But when we work with a relationship, the boundaries are multiplied. Yes, we monitor the boundary between ourselves and each client who forms that relationship, but we also monitor the boundary between each member of the relationship. Stephen Karpman’s drama triangle can take on an interestingly multidimensional feel to it because we can be one client’s Rescuer while simultaneously being another client’s Persecutor.

4) The blame game: Linked to the drama triangle, we also need to tread carefully as counselors so that we avoid the blame game. All relationships engage in the blame game to some degree, no matter how hard its members try to avoid it. To reduce the frequency, however, we should keep returning the relationship’s focus back to the present moment. The focus should be more on what is happening rather than on why — and who may or may not have caused it. Frequently, an opportunity exists to work together to resolve things, and the collaborative nature often can form a new bond.

One big step toward this is to adopt a relative perspective: There are no absolute rights and wrongs, there is only perspective. If each member of the relationship can show the other member(s) that they are willing to adopt this approach, it can allow for disagreement.

5) Commitment issues: I have often worked with relationships in which one individual was more committed to therapy than was the other(s). The shadow side of this is that sometimes the committed member of the relationship really wanted proscribed therapy for their “problematic” partner(s). They were not interested in looking at how each member of the relationship might have caused problems for the relationship and how that all interacted. This needs to be tackled early on if the work is going to continue. The party who appears “committed” to therapy needs to understand that all members of the relationship are clients, and all members need to examine how their processes may impact on the relationship.

6) Fine-tuning rather than replacing: Our job as counselors is to observe the relationship, witness reports by the clients in the relationship about interactions, create hypotheses about where things might be going wrong, and then help the relationship to establish a revised approach to these issues.

Often, members of a relationship will assume that the relationship is fundamentally flawed. After all, clients rarely seek help unless things have started to go seriously wrong. At this point of crisis, it is hard for them to see how different things could be with a simple fine-tuning instead of a complete replacement. Our job is to support them as they try this fine-tuning. We need to emphasize the strengths and resources that exist in the relationship.

7) Building foundations, not fighting fires: As we emphasize their strengths, we will help the members of the relationship look to the future by developing strategies to resolve their issues. To do this, to really build the foundations of a sustainable relationship, we need to avoid the temptation of looking to the present or the past and trying to fight every issue that erupts.

Instead, we can teach members of the relationship about assertive communication. Often, people don’t really understand the difference between assertive, aggressive and passive (or manipulative) behavior. Counselors should monitor their work for assumptions made about assertiveness, including gender assumptions. For example, I have worked with male clients who have reported quite damaging experiences with therapists who jumped to conclusions about the male member of the relationship, forming an alliance with the female member of the relationship and overlooking (or remaining unaware of) her bullying behavior.

Empathic listening is another key skill to teach the members of the relationship. When I focus on this, I really stress the words “understanding” and “support.” It can be transformative for members of a relationship to see that their partners are willing to try and see the other person’s perspective. It can also help because they are showing their partners that they are willing to support them and help them work it out as a union. The worst feeling is when someone is struggling and they feel they are struggling alone because no one is willing to try to understand and support them.

8) The whole is greater than the sum of its parts: Our clients bring their histories into the relationships they form, no matter how much they try to avoid this. There are parts of them that are made fragile — broken even — because of people from their past. The other members of the relationship might not even know this until they come across that part of their loved one and there is a subsequent explosion, withdrawal or threat of an end to the relationship. Our job as counselors is to help each member of the relationship gain perspective on this. Each member needs help in seeing that this wound is from the past and that agreement may need to be formed about how members of the relationship will approach this in the future.

One example is the wound of discrimination. Counselors should not underestimate the impact that the experience of discrimination has on a person’s ability to trust and form relationships. With members of the relationship who are ethnic or religious minorities or part of the LGBTQ+ community, counselors need to assess not only how much this discrimination affects their relationship now but also what experiences of discrimination each member of the relationship has endured in the past. For example, if one of the members of the relationship grew up as gay in the 1970s, they would have a vastly different outlook on their sexual identity and their relationship than would someone who grew up as gay in the ’90s.

When I worked at an LGBTQ+ organization in London, we encountered a number of Muslim asylum seekers who were fleeing homophobia in countries such as Uganda, Pakistan and Bangladesh. The wounds they brought to a relationship were vastly different from those experienced by their partners who had grown up as Christian gay men, or even Muslims, in London. 

9) Basic structuring: As I have outlined, there are additional complexities to working with relationships. There are multiple layers of boundaries to manage; there are in-person, live playouts of the dynamics within the relationship; there are greater opportunities for our personal values to be leaked; and there are greater opportunities to unintentionally form an alliance with one member of the relationship over the other(s). As a result, the basic structure of a therapy session with a relationship should be different. Sessions will tend to be longer than the typical “therapeutic hour,” and counselors should offer to see each member of the relationship separately as part of the assessment process. 

10) The healing power of play: To help the relationship develop open channels of communication, counselors might consider offering clients an exercise or two to try outside of session. There are a wide range of exercises available, including the Johari window (developed by Joseph Luft and Harry Ingham) and the various exercises (even card games) available via the Gottman Institute. Games and exercises can loosen things up a bit, opening the possibility for people to release the roles they may have been adopting in the relationship. The Johari window helps people discover their own, and other people’s, blind spots. With greater self-awareness, and greater awareness of the other people in the relationship, it is easier to communicate feelings and needs. Without open communication, mistrust is inevitable, and a relationship without trust is like trying to grow a flower without light.

 

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Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Before becoming a counselor, he practiced as a lawyer and taught law at the postgraduate level in the United Kingdom. Contact him at chris@exploretransform.com or through his website at exploretransform.com.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Relationship management

By Laurie Meyers January 24, 2019

Consider the words of a certain New Jersey troubadour:

Everybody needs a place to rest

Everybody wants to have a home

Don’t make no difference what nobody says

Ain’t nobody like to be alone.

This declaration is from Bruce Springsteen’s 1980 single “Hungry Heart,” which tells the story of a restless man who believed contentment could be found in ceaseless wandering, in never putting down roots or making connections. Over the years, however, the man realizes that he is alone, tired and lonely. Without close relationships, he has nowhere to turn when he is weary and in need of succor. He comes to understand that “home” can be found in the people we are close to.

“Hungry Heart” was Springsteen’s first top 10 hit as a performer. The song’s memorable and upbeat melody may partially explain its popularity. But perhaps its appeal also comes from listeners’ recognition of an essential truth revealed in its lyrics: People are not meant to go through life alone.

“We are social creatures,” says David Kaplan, who is retiring this month as the American Counseling Association’s chief professional officer. “We are meant to be with other people. We thrive with other people. Communication [with others] promotes community and a sense of connectedness. Lack of communication promotes isolation and dysphoria. It also predicts an earlier death.”

Indeed, research has shown that social relationships serve as a buffer against stress and are a protective factor against the risk of disease. According to a research review published in the May 2015 issue of the journal Current Opinion in Psychology, in the face of chronic adversity, adults who are socially integrated — meaning that they possess a network of close relationships — have a 50 percent higher survival rate than those who are socially isolated. In fact, social support has a more significant effect on mortality than do behavioral risk factors such as obesity and alcohol consumption.

The effect of social relationships on health is both direct (e.g., promoting well-being) and indirect (e.g., reducing or blocking exposure to stressful events or minimizing the physical effects of stress). Recent research has focused on how social relationships minimize the impact of stressful events. The body responds to acute stress by mobilizing the neuroendocrine, autonomic, immune and metabolic systems. Over time, this mobilization can cause wear and tear on the body (called the allostatic load). Social support seems to lower the body’s allostatic load — with support being a key word. Research indicates that it isn’t enough to simply have social “ties.” Not surprisingly, negative, stressful relationships can actually have an adverse effect on a person’s physical and emotional health.

Of course, professional counselors, who build their work around the therapeutic bond, are already well aware of the vital role that supportive relationships play in people’s lives. Using this crucial relationship, counselors can help teach clients how to cultivate and maintain healthy relationships in all areas of their lives.

Why can’t we be friends?

The bonds formed between friends can be just as important as those within families. But in our fast-paced, global and mobile society, maintaining friendships can be challenging, especially as adults. People move away, develop new interests or start families and find it difficult to consistently make time for those outside of their family units. Suddenly, adults can find their friendship pool depleted, and they’re left struggling to remember how to make new friends.

As children, we are placed in environments that make it easier to form bonds. We go to school with others our age and participate in shared interests such as club activities and team sports. But as adults, these kinds of opportunities aren’t as readily available, notes Kailee Place, a licensed professional counselor (LPC) in Charleston, South Carolina, whose specialties include helping women with relationship difficulties. As a result, adults generally have to actively seek out ways to meet people and build bonds.

One way counselors can assist in this effort is by brainstorming with clients about their interests and values, thus making it clearer what types of things they are looking for in their adult friendship, Place says. “Counselors also model healthy relationship dynamics in the therapeutic environment, providing room for vulnerability without judgment, actively listening to [clients], providing feedback and generally fostering respect and compassion. This helps lay the groundwork for healthy relationships in the future or can challenge any current toxic relationships [that clients] may have,” Place says.

“Sometimes, clients need a refresher course on social skills and social cues,” Place continues. “This includes how to use small talk to build into more substantial conversation, how to maintain eye contact [and] how to recognize different facial expressions or the meaning behind different tones of voice. During counseling sessions, we can practice these skills [with clients], perhaps using role-play activities, going through exercises to recognize and identify facial expressions, working toward greater comfort with eye contact and gaining comfort in sharing details about themselves.”

Active listening is another essential skill for developing and maintaining adult friendships, says Kaplan, a past president of both ACA and the International Association of Marriage and Family Counselors, a division of ACA. As he explains, when people listen to someone else and then reflect back in their own words what that person just said, it conveys a message that the speaker matters to the listener. And how do clients learn the skill of active listening? By practicing, Kaplan says.

Melody Li, a licensed marriage and family therapist in Austin, Texas, agrees. She often has clients sit facing a partner, a family member or Li herself to practice reflecting back not just what the other person said but also the corresponding emotions embedded in the communication.

Part of being present and attuned is meeting a partner at a similar emotional level, Li explains. For instance, if a person is recounting something that angered them, such as an incident at work, and the listener conveys nonchalance, then the speaker will feel not only unheard but unsupported, she says.

Sherry Lewis is an LPC in Boulder, Colorado, who specializes in helping individuals, parents and families develop stronger emotional and relationship skills. She also holds workshops for children and adolescents on friendship skills and says that much of what she teaches in those workshops can benefit adults as well. In fact, Lewis regularly encourages parents to “listen in.”

“With the kids, we brainstorm things they think make people like or dislike others. Then we go back through the list and rethink the things listed,” she says. “Almost everyone, consciously or unconsciously, tries superficial ways to be liked or accepted by looking a certain way, performing or doing things to be liked, etc., but those are not the things that really make a difference. As the kids in the classes cross off more of the things they originally thought made friends, such as being smart, having things, being good at sports, art, etc., I ask them if they see a pattern. The kids figure out that it’s the way we treat others and how we make them feel that underlies others wanting to be around us more or less. This realization makes friendship less of a mystery and something anyone can improve by acting in ways that make others feel comfortable or positive.”

Lewis adds that maintaining social skills is an ongoing process that everyone needs to practice across the life span as they interact with the people in their lives. From Lewis’ perspective, we have become technologically overconnected as a society, while simultaneously allowing ourselves to grow personally disconnected.

Similarly, Li thinks the rise of social media has had an overall negative effect on people forming and growing interpersonal connections. She argues that social media “can give people the impression that they’re making a connection. A bite-sized piece of connection feels gratifying in the moment, but it is not satiating or meaningful in the long run.” She also believes that the frantic nature of continuously updating social media and news feeds has shortened people’s attention spans and harmed their ability to listen patiently.

Kaplan, on the other hand, doesn’t think that social media interferes with people starting and maintaining relationships. In his view, it is just another way to communicate, and frequent communication is essential to relationships.

“There needs to be quantity,” he says. “It might be online, verbal or face-to-face, [but] in one form or another, there’s no substitute for a quantity of communication with people that you care about.”

Kaplan and Li do agree about the adverse effects of another area of technology, however — the practice some people have of repeatedly scanning their smartphones while interacting with others. Although quantity of communication is important, so is quality, and being able to give full attention to what others are saying is a critical component of forging relationships. When spending time with someone they care about, people should put their phones away, Kaplan says. That advice might seem elementary, but in this day and age, counselors likely need to share it with clients who are working on their relationship skills:   

Feeling awkward

Making and maintaining new connections can be especially difficult if a client is shy or has social anxiety. All hope is not lost, however.

“Counselors can help immensely with debilitating shyness or social anxiety,” Place says. “Most people have some amount of anxiety or nerves when approaching new people, especially if the motivation is building a friendship.”

Place suggests that clients who struggle with social anxiety use grounding techniques such as slow, intentional breathing; carry a small object to fiddle with to channel nervous energy; or use a lotion with a calming scent such as lavender.

“I also encourage clients to challenge any irrational thinking they may be experiencing, such as dwelling on the assumption that people don’t like them, and to come to more accurate conclusions with the proof they have in front of them,” she says. “Keeping the mantra ‘this is temporary’ in mind is also helpful [because] emotions come and go, so those anxious feelings will come and go as well.”

Eventually, Place says, clients have to test their coping skills in the real world so they can build confidence and experience. “Starting out small and safe is key to building a base of confidence and motivation,” she explains. “This can include striking up a conversation with a co-worker that a client feels relatively comfortable around or getting involved in a class of some sort where most people have a common interest. That common interest or common environment can take away the pressure of coming up with subjects to discuss. As these interactions go positively, clients see their ability and, ideally, build their energy and motivation toward more difficult social interactions.”

Li says it can be helpful for clients to be upfront about telling people that they’re shy and often don’t speak up right away but still welcome interaction.

Sometimes anxiety arises because the client feels socially awkward. “We’re all awkward. Some of us just fake it better than others,” says Li, who encourages clients to own their awkwardness and be open about it. She also works with clients to determine if there is something specific that is driving their perceived awkwardness, such as a particular incident or trauma.

Playing (and working) well with others

People might not automatically associate relationship skills with the workplace. Yet most people spend a significant amount of time at the office, which typically requires lots of interacting with co-workers. Negative office relationships not only contribute to unpleasant or downright dysfunctional environments; they can also affect how — or whether — clients fulfill their professional responsibilities.

Jessi Eden Brown is an LPC and a licensed mental health counselor in the Seattle area who specializes in workplace-related stress, work trauma and workplace bullying. She tells her clients that they don’t have to be friends with their co-workers; instead, they should strive for mutual respect and professionalism. Friendship — if it happens — is a bonus.

In addition to honing basic relationship skills such as having empathy and compassion, developing self-insight and being more accommodating, Brown teaches clients how to set a tone for working with others, how to give and receive feedback in the workplace, and how to resolve conflict.

Brown, a member of ACA, most frequently brings up tone setting when clients are preparing to start a new job or project, accept a transfer or change careers. “The process involves helping clients reflect on any changes they might want to make as they start over,” she says. “I often frame it as a way to redefine who you want to be at work.”

“Setting the tone includes thinking about relationships in the workplace. We’ll explore questions such as how much about yourself do you want to share with your new co-workers? Are there any reasons to be cautious at first — as is generally the case with bullied targets who are starting over? What strengths would you like to showcase? In what ways do you want to grow professionally? Are there any habits or behaviors you want to leave behind?”

Defining the desired tone allows clients to identify their goals and then work with Brown to brainstorm steps for achieving them. Brown believes this helps create a road map for clients to correct previous problems and approach situations in a new way. Once Brown and the client have developed that road map, she uses psychoeducation, modeling and role-play to work with the client on any specific skills that might be required, such as assertive communication skills, impulse control and anger management.

Giving and receiving feedback is an essential, yet frequently unpleasant, part of workplace relationships. Brown encourages clients to use “I” statements and to engage in reflective listening. When giving feedback, she is a fan of the feedback “sandwich,” in which the person providing the feedback opens with a positive statement about the recipient’s performance, follows up with an explanation of what the recipient needs to work on and closes with a general positive comment such as, “Overall, you’re doing really well.”

On the other side of the coin, Brown encourages clients to approach receiving feedback with an open mind, reminding themselves that they will probably hear information that they won’t like. Another piece of advice she gives: “You don’t have to respond in the moment — ever. If you hear feedback and feel defensive, tell them [the person giving feedback] that you need time to respond.” Clients can then take that time to ask themselves why they reacted defensively and to consider how they want to respond to the feedback, Brown says. Taking the needed time to gather their thoughts allows clients to re-engage and enter into a more productive discussion concerning the feedback, she explains.

All relationships have conflict, but conflict in the workplace can be particularly uncomfortable, especially if it involves a power differential, such as an employee who has a run-in with a supervisor who signs the paychecks. Brown starts by trying to normalize conflict for her clients, telling them that it’s everywhere. She also advises clients to observe their co-workers.

“Is there someone at work who seems to handle conflict particularly well? How are they doing it?” she asks. “You may even be able to tap them for information.”

Brown recommends that clients take a direct, solution-focused approach to dealing with conflict, including coming to the table with ideas for resolving the problem. If that approach doesn’t work, she advises clients to go through official avenues such as the human resources department.

But what happens when the conflict is with a supervisor or co-worker who doesn’t respond to attempts to resolve the issue? Under such circumstances, Brown works with clients on ways to not internalize the conflict. When clients look around at the larger picture, she says, they often find that they aren’t the only target of conflict — the problematic manager or co-worker behaves that way with most people. Brown also encourages clients to try to apply the lens of humor to the situation or to find other ways to keep the conflict in perspective, such as reminding themselves that this represents only one area of their lives. It doesn’t stop them from continuing to engage in positive interactions with friends and family or from seeking their support.

Of course, conflict isn’t the only kind of drama people encounter when it comes to relationship dynamics in the workplace. Power struggles, gossip and general office politics can create an uncomfortable and precarious atmosphere, notes Maggie Graham, an LPC in the Fort Collins, Colorado, area who specializes in career counseling and coaching.

“If people are … mired in a situation where office politics are swirling around them, and they want to avoid getting pulled into the vortex, simple cues and redirections can be very effective at communicating a clear boundary around gossip while steering clear of judging and alienating co-workers,” she says.

Graham recommends techniques such as changing the topic when conversations veer into murky waters and using body language and clear statements to set boundaries. For example, she suggests clients can gently hold up a hand like a stop sign and say, “Oh, that’s not a topic I want to chime in on. It’s outside my scope of expertise.”

Taking a chance on romance

Much has been written on nurturing established romantic relationships, but what skills do clients need when still looking for love?

“Clients with attachment issues or relationship anxiety may deeply want a relationship but also fear it working out,” notes Rachel Dack, a licensed clinical professional counselor with a private practice in Bethesda, Maryland, who specializes in helping clients with dating, relationship and intimacy issues. “Fear may lead individuals to play games in dating or sabotage developing relationships due to not feeling worthy or confident that someone could actually like them. The fears can be so deeply ingrained that they approach dating with walls for protection or mental blocks that don’t allow them to connect despite really wanting a partner.”

Understanding behaviors that are driven by attachment issues, relationship anxiety and other internal belief systems is often a crucial part of resolving dating difficulties, says Dack, a member of ACA. For example, Dack had a single client in her 40s who repeatedly spent money on prospective partners and insisted on paying for everything while dating.

“She would plan elaborate dates and vacations for the men she was interested in and used her financial assets as a means to connect,” Dack says. “She often felt insecure and anxious that men didn’t want to date her. When we explored her belief system, she had deeply rooted beliefs that she was not good enough and was unworthy of being picked by a great guy.”

The client’s reliance on using money to attract men was ultimately self-defeating, Dack says, because even when someone continued to date her, she couldn’t help but question whether he would have asked her out if she hadn’t paid for everything. This created a constant sense of rejection in the client despite her success in getting dates.

“She [also] had a tendency to dominate the relationship when it came to logistics — planning dates, picking activities, paying all of the time — while holding back her feelings and acting standoffish with men despite her interest,” Dack explains. “She didn’t know how to relate to the men who wanted a more equal relationship in which they could also be generous and giving because she was scared they wouldn’t like her if she stopped paying. We worked to explore her underlying belief system and her thoughts on gender roles, healthy relationships, money, herself and men.”

Dack helped the client look at how these beliefs shaped her behavior and encouraged her to ask herself whether her approach was serving its intended purpose. “She realized that her negative mindset was interfering with her goal of a healthy partnership and that she wasn’t giving men the opportunity to get to know her in a deep way,” Dack says.

Together, they discussed how the client might behave differently if she believed she was worthy of love. Dack encouraged the client to allow herself to be more vulnerable by letting a man pursue her. She also urged the client to become more emotionally invested in her relationships.

“It was hard for her to accept a man who wanted to make her feel special, but she learned to become more comfortable with this through time and practice tolerating the discomfort,” Dack says. Dack also helped the client learn how to love and care for herself, which allowed her to accept love and care from others.

The process of forming an intimate connection — from early conversations to going on actual dates — can be a very scary or overwhelming undertaking for many people, Dack observes. She reminds clients that many of the negative scenarios they fear do not end up happening. Dack also helps clients reframe bad dates and past relationships — not only did the clients survive them, but they learned something that they can use going forward. “Clients often feel better when they take emotional risks aligned with their romantic goals [but] can feel hopeless when they avoid taking risks or give up on dating entirely,” she observes.

To prepare for dates, Dack has clients practice their active listening, communication and validation skills. “The balance of how much to speak and share versus how much to listen can be tricky to maneuver,” she says. “Often, clients fall on one extreme — either they are so eager to share about themselves that they do too much talking and oversharing, or they are very introverted, shy or scared to be vulnerable, so they prefer to sit back and do all of the listening.”

Many clients struggle with how to create a natural conversation flow, Dack adds. One of her clients, a man in his early 30s, had trouble getting more than one date with the women he pursued. He told Dack that women often said they didn’t feel a connection with him. As Dack and the client discussed how he typically interacted on dates, she helped him realize that because of his anxiety about potential rejection, he would ask numerous questions but not truly take in or indicate interest in his date’s responses.

Dack used role-play to train the client to slow down his questions, listen attentively and stay on topic for more extended periods of time. The client also practiced sharing his own experiences and emotions. “We explored what it means to connect and practiced validation skills so that his dates would feel heard, valued and understood,” Dack says.

Over time, the client’s enhanced ability to engage allowed him to achieve much better connections — and led to relationships that have extended well beyond one date.

 

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The power of forgiveness

“Forgiveness is important to relationships for many reasons, but primarily because it is a mechanism of healing ruptures that occur in all relationships,” says Veronica Johnson, an American Counseling Association member whose research focuses on forgiveness, conflict resolution and infidelity.

People who refuse to practice forgiveness in their relationships experience resentment, bitterness and anger, which can cause both physical and psychological problems, points out Johnson, an associate professor and chair of the Department of Counselor Education at the University of Montana.

Another reason forgiveness is essential to relationships is because it restores a sense of dignity and trust to both parties, Johnson says. “The offender is released from guilt and shame … [for] what they did, and the victim lets go of a desire to seek revenge and continue to punish their partner,” she explains. “In the presence of a good apology — which is also quite important in relationships — the victim’s dignity is also restored [because] they are validated in their experiences.”

Forgiveness, however, first requires a willingness to forgive, Johnson emphasizes. “Allowing clients the space to express the anger, resentment, grief, sadness and other host of emotions that accompany a relationship rupture is absolutely essential,” she says. “Only after the client feels validated and heard in expressing their experience can a counselor begin the process of helping the client see the effects that active unforgiveness has on their life.”

Johnson recommends Robert D. Enright’s book Forgiveness Is a Choice: A Step-by-Step Process for Resolving Anger and Restoring Hope as a resource. Enright emphasizes that therapists should never imply that clients must or even should forgive.

“Implying such can be experienced as blaming or retraumatizing for a client,” Johnson says. “We can help clients to see how their active unforgiveness impacts their life, and when they are ready to free themselves from the hurt, anger, bitterness, etc., then forgiveness becomes an option. The process of forgiveness that Enright proposes involves allowing oneself to fully experience the range of emotions that accompany the offense, actively choosing to forgive, working toward forgiveness by developing understanding and compassion for the offense and the offender, and discovering meaning, purpose and release from negative emotions associated with the offense.”

Johnson adds that forgiveness need not be accompanied by reconciliation. “We need to empower our clients to make decisions that are healthy for themselves and their relationships, and sometimes that might mean leaving an unhealthy relationship,” she says.

If the client is leaving an unhealthy relationship, the forgiveness work often shifts to self-forgiveness. These clients often need to learn how to forgive themselves for staying or for tolerating bad behavior in their partners, Johnson concludes.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books and DVDs (counseling.org/publications/bookstore)

  • Relationships in Counseling and the Counselor’s Life by Jeffrey A. Kottler and Richard S. Balkin
  • Mediating Conflict in Intimate Relationships, DVD, presented by Gerald Monk and John Winslade

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Imago Relationship Therapy” with Susan Hammonds-White (ACA284)
  • “Love and Sex and Relationships” with Erica Goodstone (ACA231)

 

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.